HomeMy WebLinkAboutPLBG2025-002904ADDRESS
4311 Country Ln.
Grapevine, TX 76051
LEGAL
Shadow Glen Addition
Blk 1 Lot 37
S
*05783119*
PERMIT HOLDER
Jerry Carter
TIOGA CONTRACTORS
LLC
(682) 224-0757
COLLABORATORS
•Jerry Carter
TIOGA
CONTRACTORS LLC
(682) 224-0757
OWNERS
•Mackenzy Embry
INSPECTIONS 2
1. Plumbing Water Heater 2. Plumbing Final
INFORMATION FIELDS
**APPLICANT NAME (Individual)Carol Webb
**APPLICANT PHONE NUMBER 682-224-0757
VALUATION 6928
DOCUMENTS - MISC 01 4311 Country Ln.pdf
FEE TOTAL PAID DUE
Plumbing Miscellaneous Fee $ 37.00 $ 37.00 $ 37.00
TOTALS $ 37.00 $ 37.00 $ 0.00
READ AND SIGN
I HEREBY CERTIFY THAT THE FOREGOING IS CORRECT TO THE BEST OF
MY KNOWLEDGE AND ALL WORK WILL BE PERFORMED ACCORDING TO
THE DOCUMENTS APPROVED BY THE BUILDING DEPARTMENT AND IN
COMPLIANCE WITH THE CITY OF GRAPEVINE CODES REGULATING
CONSTRUCTION. IT IS UNDERSTOOD THAT THE ISSUANCE OF THIS PERMIT
DOES NOT GRANT OR AUTHORIZE ANY VIOLATION OF ANY CODE OR
ORDINANCE OF THE CITY OF GRAPEVINE.
I FURTHER CERTIFY THAT ALL WORK THAT IS REQUIRED TO COMPLY WITH
ANY FEDERAL, STATE, AND / OR LOCAL LAW REGARDING ENERGY
CONSERVATION WILL BE PERFORMED IN ACCORDANCE WITH THOSE
LAWS, AND THAT VERIFICATION OF ENERGY CODE COMPLIANCE SHALL BE
SUBMITTED TO THE CITY UPON REQUEST.
July 29, 2025
Signature Date
City of Grapevine
PO Box 95104
Grapevine, Texas 76099
817) 410-3166
Plumbing Permit - MISC
Project # 25-002904
Project Description: Replace 62 Ft wtr line from water meter to
the house, Install PRV and 50 gal gas water heater in hall
closet.
Issued on: 07/29/2025 at 8:19 AM
MYGOV.US 25-002904, 07/29/2025 at 8:19 AM Issued by: Connie Cook
Page 1/2
Texas Commission on Environmental Quality
BACKFLOW PRE VENTION ASSEMBLY TEST AND MAINTENANCE REPORT
The followin-, form must be completed for each assernblk; tested. A sii.,.ied and dated odeinal must be submitted to the public water supplier for recordkmvint; *pun,oses-
NAME OF PWS: Graoevine
i PWS mg: ?2Ci.C10M
j. PWS MAILING ADDRESS:
PWS CONTACT PERSON: Backflow Coordinator
AbDRESS OF SERVICE' :
The back low prevention assembly detailed 6dow has'been tested maintained as required by comrnission regulations
and is certified to be operating within acceptable. parameters.
TYPE OF D'ACKF LOW PREVE ION ASSEMEBLY (BPA):
n
n! Reduced Pressure Priciple (RPDA) rl Reduced Pressure Principle -Detector (R-PBA-D) 1 Type 11 Ell
ou e :0 Double Check -Detector (DCVA-D) Type II in
I D ble Check Valv (IJCVA)
Pressure Vacuum Breaker (PVB)' Spill -Resistant Pressure Vacuum Breaker (SVB)
Manufacturer: j Main - Size:
Bypass--! Mrain: Bypass:)
Model Number: i Main: Bypass.q! BPA Location:
Serial Number. !1 Mlaiw B ss,1; BPA Serves:
ypa
PERMIT NUMBER:
Reason for test., !New !Eli, 1 Existing Replacement 10 ,11 I
1 Old Model/Serial
Is the assembly installed in accordance with manufacturer recommendations and/or local codes? IQ 1yes 10, NO
Is the assembly installed on a non -potable water supply (auxiliary)? 0 tyes 11,521 No
TEST RESULT
r
[Reduced Pressure Principle Assembly (RPBA) AsUmhiy�PVB SVB
T
PAS I DCVA
L d Relief Valve Bypass Check Air Inlet Check Valve
d ' "' ' - I
FAIL 0 1 " Check 2 Check*** _f 1'7"'ve
_j Relief
,,d at 14,1 psid
Initial Test Held 7at�,� psid Held at psid Opened at 1 Held at psid Opened at psid Held at
Tight
C1
se psid CIO 101 psid
Date:
Closed Tight Ell Closed Tight Closed Tight ;E] Did not open
d t L
Time: Did not Le D
'n Leaked Leaked
Leaked Did it fully op Lealed
open 1171,1 (yes I® IN, 10)
Repairs and 'Maine i
Materials
Used** Bypass;
Test After Held at psid Held at'----J psid
ps
Repair Closed Tight 171' Closed Tight
T. qg�
Date:
Eli
D . Time.
Differential pressure ressure gauge used:
Make/Model:
':
Remarks:
i Company Name:
411
A
Company Address: 1'.
�c
M
14e)d at
Closed psid
Tight:O
at, 1114eld at 'psid I- Opened at psid
tired for DCVA on1v
Potable: Non -Potable:' Cli
_tBate tested for accuracy
Licensed Tester Name
(Print/Type),,
Licensed Tester Name (Signature):
Company Phone#: V
t PAT License ff
License Expiration Date: i.
The above is certified to be troll at the time of testing.
TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS (30 TAC §290.46(B)1
** USE ONLY MANUFACTURERS REPLACEMENT PARTS
I
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